Provider Demographics
NPI:1821736802
Name:VARBLE, JERSHON EVAN
Entity Type:Individual
Prefix:
First Name:JERSHON
Middle Name:EVAN
Last Name:VARBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E 1500 N
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84404-7727
Mailing Address - Country:US
Mailing Address - Phone:801-644-5501
Mailing Address - Fax:
Practice Address - Street 1:2572 E SOUTH WEBER DR STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH WEBER
Practice Address - State:UT
Practice Address - Zip Code:84405-9550
Practice Address - Country:US
Practice Address - Phone:801-479-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12775190-8016208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation